Healthcare Provider Details

I. General information

NPI: 1730634254
Provider Name (Legal Business Name): DANIEL T SHREVE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 HAZARD AVE
EAST PROVIDENCE RI
02914-3309
US

IV. Provider business mailing address

47 HAZARD AVE
EAST PROVIDENCE RI
02914-3309
US

V. Phone/Fax

Practice location:
  • Phone: 401-434-9100
  • Fax: 401-434-4732
Mailing address:
  • Phone: 401-434-9100
  • Fax: 401-434-4732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberMD03558
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberMD03558
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD03558
License Number StateRI

VIII. Authorized Official

Name: DR. DANIEL T SHREVE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 401-434-9100